Gone, But No Longer Forgotten

For the past 14 years, representatives of the Hawai‘i State Hospital and supporters from the larger community have come together above a peaceful cul-de-sac at Hawaiian Memorial Park cemetery in Käne‘ohe for a special memorial service. They gather around two large, but simple bronze plaques, each bearing the names of hundreds of former psychiatric patients from what was then known as the Territorial Hospital.

The words, all in capital letters, at the top of the first plaque explain the circumstances.

“Here rest in eternal peace the mortal remains of some six hundred and sixty-eight men and women. Once patients of the Territorial Hospital in Käne‘ohe, their cremated remains, accumulated over three decades, were inurned here on July 1, 1960. On that date, a special ceremony was held, attended by many people, honoring these dead.”

The plaques are easy to miss if you aren’t looking for them — or even if you are, as I was. They lie flat on the ground, a single vase between them. There is no embellishment and ornamentation. And while they are only a stone’s throw away from some of my own family members’ individual headstones further down the gently sloping hill, I never knew the plaques existed until recently.

It took me a while to locate them on a recent Sunday afternoon visit to the cemetery as I wandered about the grassy plain, studying every headstone.

When I finally found the plaques, the impact was startling. So many names: column after column after column. The names reflected the diversity of Hawai‘i’s ethnic history: Amaral, Arakaki, Tanabe, Bautista, Cortez, Hartmen, Inouye, Chin, Mercado, Martin . . . Literally hundreds of names. I stood there for a long time, reading each one of them, realizing that behind each name was a human life with a face and a story. I thought of the words of Mark Twain, who once said that everyone has an interesting story and that behind even the dullest exterior, there is a drama, a comedy and a tragedy.

I don’t profess to know the specifics of their stories, but I surmise that they likely experienced some deep challenges along their life’s journey — not only mental, but also possibly physical and spiritual — to such an extent that they ended up as patients at the Territorial Hospital. But, along that same journey, one would hope that they also experienced love, happiness and a sense of belonging.

The story takes a sad turn when one reflects on what happened to these people after they died.

From 1930 to 1960, Hawai‘i law “prohibited using taxpayer funds to bury indigent patients who died while residing at the Territorial Hospital,” notes a state Department of Health press release. “If unclaimed by family members, their remains were cremated at the hospital and the ashes stored in the basement of the hospital’s administration building.”

Attendees placed flowers on the two plaques bearing the names of the former patients.

This was a different time, when society’s knowledge and understanding of mental illness — and how to treat it — were still evolving.

In the March-April 1956 edition of the Hawaii Medical Journal, Dr. Robert A. Kimmich, then-medical director of the Territorial Hospital, authored an article titled, “100 Years of Hawaiian Psychiatry.” In it, Kimmich traced the history of mental health treatment in the Hawaiian Islands.

The predecessor to the Territorial Hospital was the Oahu Insane Asylum, which was established when Hawai‘i was still a kingdom. Today, this name would be inappropriate, but in the latter half of the 1800s, these kinds of institutions often were known as insane asylums. Although it was difficult to get funds to build the “asylum,” it was finally opened in 1866 at the corner of School and Lanakila streets, according to Kimmich’s article.

“At the time of its opening,” Kimmich wrote, “six patients were transferred to it from the jail.” The 1867 annual report mentions a total of 62 admissions, with 40 years old being the average age of the patients.

Kimmich wrote that during this period in Hawai‘i’s history, the mentally ill often faced public scorn and were ostracized in the community. They were also stigmatized as “mental and moral weaklings.” The establishment of a hospital to house and treat psychiatric patients, however, was seen as a move in the right direction, although it was hampered by the lack of trained personnel and an over-reliance on physical restraints. The nicknames used to refer to the asylum — names like “Pupule (Hawaiian, meaning crazy, insane) House” — were insulting and reflected the larger society’s attitudes toward the mentally ill.

By the early 1900s, the Oahu Insane Asylum was seeking a new home. After more than two decades, a site was selected in Windward O‘ahu to construct the new Territorial Hospital. Kimmich writes that the hospital opened with 524 beds, even though a mental health expert at the time recommended a facility that could accommodate 1,000 patients. When the Territorial Hospital opened in 1930, Kimmich wrote that it was already overcrowded, having to accommodate patients from the former Oahu Insane Asylum and elsewhere.

Although incremental and enlightened improvements to mental health care accompanied the opening of the new hospital in the then-rural Käne‘ohe, attitudes and behaviors toward the mentally ill took time to change. As mentioned earlier, the remains of indigent patients who died at the hospital were left unburied for 30 years if no one claimed their ashes.

“Over time, the containers used to store their ashes deteriorated,” stated the Health Department press release, “and the ashes from broken containers eventually spilled onto the concrete floor, and many of the affixed labels fell away or became faded or illegible.” As a result, the ashes of 167 “unknown” people were laid to rest with the remains of the known patients.

In 1960, in perhaps a sign of the changing times and amid mounting public pressure, the Hawai‘i state Legislature appropriated money to provide a proper burial for the remains of these patients. The July 1, 1960, memorial service was an opportunity for the community to publicly acknowledge that these lives mattered.

About 14 years ago, the memorial service became an annual tradition of remembrance. Last October, Stephen Prusinski — known to the State Hospital community as “Chaplain Stephen” — joined the community of supporters gathered at Hawaiian Memorial Park cemetery to remember the patients whose names are engraved on the plaque. As the chaplain coordinator of Hawai‘i State Hospital Spiritual Care, Chaplain Stephen is part of a team that provides “whole-person integrated care” to current psychiatric patients at the hospital.

Although still faced with challenges, the care of mental health patients today, at both the clinical and community levels, has improved from the early days of institutionalization and includes spiritual care, for those who want it, that can help patients get in touch with what empowers them. Chaplain Stephen also credits the hospital’s medical director, Dr. Bill Sheehan, for his knowledge of best practices in mental health treatment.

Chaplain Stephen emphasized that although the annual remembrance service varies from year to year, “the main thrust” is to honor those who were forgotten at one time in history and to reaffirm the sacredness of human life. Last October’s service included elected officials and community leaders, but Chaplain Stephen, who has been with the Hawai‘i State Hospital for three years, was especially proud of two speakers who went through the hospital’s treatment program and “shared how the system benefited them and how to get through it (successfully).”

In a phone interview, Chaplain Stephen read from last year’s remembrance ceremony program, which he worked on with fellow hospital staff member, Chaplain Jessica. “We together claim the future for a meaningful life with mental illness,” he read. “It wasn’t right that it took nearly 30 years for some of these listed on the plaque to receive a proper burial, but persistence and the integrity of key leaders and community members helped to right that wrong.”

Today, there is a much greater focus on community reintegration and community-based support and services than on mass institutionalization. However, some mentally ill people still face a certain degree of social alienation, especially if their particular set of challenges has resulted in encounters with law enforcement or the court system. Patients who have been able to successfully reintegrate into the community, however, can serve as role models and peer supporters for those who have yet to make that transition.

Although the Hawai‘i State Hospital has had its share of negative media attention in the past, Chaplain Stephen likes to think of the hospital as “a place of healing” and somewhere safe to live. For some patients, given their troubled lives and broken families, the hospital may be the safest place they’ve ever been.

He said the remembrance service allows the community to see how the “past connects to the present and how the present connects to the future.” It is a time to contemplate respect, honor and hope.

It’s hard to imagine a more beautiful final resting place for a person’s mortal remains than Hawaiian Memorial Park cemetery, where the former indigent patients — known and unknown — from the Territorial Hospital are now memorialized. The majestic Ko‘olau mountain range provides a dramatic backdrop in one direction, while, in the opposite direction, the calming waters of Käne‘ohe Bay seem to lead to an eternity of blue hues that stretch into the horizon.

The serenity that may have eluded some of these once-forgotten human beings in their lifetime now embraces them forever.

Kevin Kawamoto is a longtime contributor to The Hawai‘i Herald.

POSTSCRIPT

So often when we tell stories about the lives of Asian immigrants in Hawai‘i, we focus on the “successful integration narrative.” We’ve created our own Horatio Alger stories about successfully overcoming hardship and obstacles through a “can do” attitude and an admirable spirit of perseverance. Moreover, our narratives about the second-generation — the immigrants’ offspring — are filled with examples of individuals who rose to social distinction and even heroism, despite the challenges of racism and poverty.

But as I looked at those names on the plaques, I noticed that a lot of them sounded like immigrant names — names like Kakutaro Shozo, Sin Pan Sik, Ah Leong Siu, Kim Young Soon, etc. We don’t have many stories about those who perhaps couldn’t adjust and assimilate after they arrived in Hawai‘i. It may have been all too much and overwhelming for them — whatever it was they had to endure — or it may be that they had pre-existing mental disorders or developed them after arriving in Hawai‘i and finding this was no paradise for the poor and politically disenfranchised.

The more than 600 people named on the plaques are only the ones who died in the hospital and were unclaimed by their families. But there must have been thousands of others who did leave the hospital or whose remains were claimed by their families. Who are all these thousands of people? What were the circumstances that led to their admission to a psychiatric facility?

We really don’t have many stories about the Asian immigrant who struggled to adjust and to succeed, but whose coping mechanisms were so overwhelmed by circumstances and perhaps by mental illness that they just could not thrive in the so-called “outside world,” especially at a time when mental illness was not well understood. These are the kinds of people whose ashes ended up in boxes in that basement storeroom of the Territorial Hospital.

I would love to get a glimpse into their lives, although it’s doubtful their files would even exist anymore or that anyone could get access to them. Perhaps in those pages would be untold stories about a different kind of resistance and resilience than we are used to hearing about — stories that don’t fit into the “successful integration narrative.” But they are likely to be stories that have been largely hidden, like the patients themselves, behind a now-distant wall of invisibility. It may not be necessary to look into those files to understand their lives because they may not be that much different from our loved ones today or even ourselves, except that they lived in a different time and lacked the range of support systems and greater social empathy available to the mentally ill today.

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The Hawaii Herald’s name has been connected with several different publications since Hawaii Hochi founder Fred Kinzaburo Makino first came up with it in October 1942. The Herald’s comprehensive and varied coverage chronicles the past achievements, current concerns and future aspirations of its distinguished community.